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Reader Question: I have surveyed correctional facilities that do not allow any Keep On Person (KOP)medicines, to include nitro and asthma inhalers, even in medically verified instances. This is presumably for Safety & Security reasons, and instituted by custody. When questioned, the response is invariably : “If the have an attack, medical personnel will respond in time.” I have some concerns about this policy. What are your thoughts?

I believe this is a difficult question. In the past we had an inmate (in one man locked down cell) go through a whole MDI in 3 days. Due to tachy and euphoria effect – he must have had a good time. We have seen pictures of a cuff key made from an inhaler canister. Our psych MD states Wellbutrin and Albuterol cause the same effect as meth in the brain leading to euphoria. We have had a patient with true angina keep 2 nitro in his cell promising to advise medical when/if he took them and why. We have also allowed a brittle diabetic to keep a few glucose tabs on person in case he crashes. Maybe it is a case-by-case basis. We do our best trying to keep our patients safe as well as the safety of others (security staff included.)

Hi Cheralee, albuterol abuse definitely happens in corrections. I also have seen an inmate who inhaled an entire MDI canister within an hour–and became delirious and hemodynamically unstable. It certainly is a judgement call, weighing the potential benefits versus the potential harms, on when to allow inmates to KOP potentially harmful meds.

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Jeffrey Keller

About

Jeffrey E. Keller is a Board Certified Emergency Physician with 25 years of emergency medicine practice experience before moving full time into his “true calling” of Correctional Medicine. He is the Medical Director of Badger Medical, which provides medical services to several jails and juvenile facilities in Idaho. Dr. Keller is available for consultation on any aspect of Correctional Medicine, including legal cases, program development, and system analysis.

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